COLUMNISTS

When Magdalene Torogi got married in 1983, it was as the fourth wife to a man 40 years her senior. She had the first of her five children at home in 1985. What should have been a happy occasion was instead a traumatic introduction to motherhood for the 19-year-old, who bled so much after the baby was born that she lost consciousness.

“They splashed me with cold water to revive me. In my community, it is taboo to drink water when you give birth; instead they pour the water on you. When I woke up, I was too tired to stand. I was given some porridge. It took several weeks for me to heal.”

She did not go to hospital because the nearest one was too far away from her Ndarkalali village. If you left the house at seven in the morning, you would get there at about midday, she says. It was also dangerous, because you had to go through a forest full of wild animals.

Her second child was born in 1987 - again at home. “Once more I was very weak after the delivery. At that time, we had migrated to the mountain with the animals. We came back from the mountain three months later. My baby had malaria, and I had to walk all the way to the hospital for medicine. It was a very difficult journey, because there were wild animals and tsetse flies on the way. They told me the children were sick because of the mosquitoes. I could not afford to buy a net, so I made one out of sheets of cloth to protect me and my babies from mosquitoes,” Magdalene recalls.

Change

When she had her third child in 1989, not only was the bleeding intense, she suffered paralysis too. Her baby was also very sick and weak. A traditional healer said that her problem was being caused by a ‘worm’ in her body, and that the only treatment was for her to be circumcised again. Fortunately, her relatives refused, but it took mother and her baby a long time to get better.

Things began to change for Magdalene in 1992, when the mobile clinics of Africa's major health organisation started to come to their village with information and treatment. “They told us that it was important for women to give birth in hospital, in the care of a trained person who would be able to help if there was a complication. I got very interested in the things they were teaching us. I began to use a family planning method, and I would take my children to the clinic when they were ill.”

But her husband was not happy with her new-found relationship with formal health care. He not only forbade her from going for treatment, directing her to use traditional herbs instead, but he even went to the clinic and instructed them never to attend to her again, as he didn’t believe in the medicine offered by the clinic.

Nevertheless, Magdalene kept going back, and her health and that of her children improved greatly. “Five years after my last delivery, I gave birth to my fourth baby. By this time, there was a health centre built in Olkiramatian and that is where I gave birth. I had no complications during and after the birth, and my daughter was also very healthy. I was so happy!”

Her fifth child was also born at the health centre. Magdalene has since joined a group of women that the before mentioned organisation helped set up to make nets for sale. She also trained as a Community Health Committee (CHC) member to pass health education messages in her village.

“We have come a long way, and things have changed a lot. When I gave birth at home, I had a lot of problems. I nearly died. I also lost one baby and the other two were lucky to survive. But after I started going to hospital, I did not have any complications,” she says. “My husband has changed too. He now sleeps under a net and when he falls sick, I take him to hospital.”

Midwife Esther Madudu

Magdelene has been lucky. Pregnancy continues to carry with it a high risk of death for both mother and child in some parts of the world and especially in the developing world. Sub-Saharan Africa is now the epicentre of maternal mortality in the world. Current trends indicate that despite global, regional and national policies to improve maternal, newborn and child health being in place, countries like Kenya are yet to attain their targets particularly for MDGs 4 and 5 (the Millennium Development Goals from the United Nations) to decrease child and maternal mortality. Every year more than 200,000 die during child birth.

To draw attention to the serious health situation of African women, the before mentioned health organisation (AMREF) supports the candidacy of midwife Esther Madudu for the 2015 Nobel Peace Prize - as a symbol of all of the African midwives and health workers fighting for African mothers. Africa needs African mothers and African mothers need African midwives! Therefore this ngo supports Esther, while at the same time 15,000 midwives will be trained from now to 2015 to reduce 25% of maternal mortality in Sub-Saharan Africa.

But who is Esther Madudu? This enrolled midwife of 31 is trained by AMREF and employed by the Government of Uganda, working at the Atirir Health Centre IV in Katine District. She has worked at this health centre for three years and in the district for seven years. Atiriri health centre IV, located just outside Tiriri trading centre in Katine, is the main facility for seven sub-counties that make up Soroti County. A health centre IV is a mini hospital. Atiriri health centre has 34 beds and sees up to 100 out-patients a day, including referrals. For a long time, it has been run by two clinical officers, but a medical doctor was recently employed there. There are three midwives at the health centre. One of them is on study leave, so Esther and her colleague have to share the workload between them. Their duties include antenatal services - including examination of the mothers, counseling of HIV-positive mothers, nutritional education, PMTCT; maternity services, including delivery; and post-natal care. Besides all the other duties, the midwives deliver 45 to 50 babies every month.

Following training she received, Esther is able to handle difficult deliveries. Those that are beyond their capacity to handle are referred to the Soroti hospital, 26 kilometers away. Atiriri health centre has an ambulance to take referral cases to Soroti, but there is often no fuel for it, so the health workers have asked the community for help in raising money for fuel.

Heavy workload

“I am very proud today to represent the work of the midwives in Africa and to raise awareness to the plight of African mothers, give them a voice and draw everyone’s attention about the urgent need of midwives in Africa.

My health centre is deep in the rural areas. It is not fenced, there is no power and the solar panels do not work. This makes our work very difficult, particularly in the maternity ward. We have been given head torches that we could at night, but these no longer work, so we use the light from our mobile phones to deliver the mothers. Sometimes the mothers come with candles, but it is not easy to do a delivery by candle-light.

There is so much work to do and yet we are very few. We are forced to work day and night. Like today, I have been on my feet all day and have not had time to eat. Most days we just take a walking soda. I do not even have time for my son because of my busy schedule. He is only 10 months old. I decided to take him to stay with my mother who lives in Pallisa in Eastern Uganda because he was spending too much time alone. The housegirl I had employed did not care for him properly because I was not able to supervise her closely.

The heavy workload also makes it difficult to do all of our work effectively. We are supposed to make follow-up home visits to HIV-positive mothers, but we are so tied down at the health centre, we cannot make the visits. Because of stigma, women do not follow our advice because they do not want other people to know that they are infected. So they do not take the Nevirapine at onset of labour, and they go ahead and breastfeed their babies, putting their babies at highly increased risk of infection.

Even though I work in very difficult circumstances, I know I do an important job. Besides the training I got in nursing school, AMREF has given me knowledge and skills in additional areas such as how to handle severe malaria in pregnancy, post-abortal care, immunisation, and complications in delivery. The training for the Village Health Teams has helped us greatly too, because most mothers are referred to us in good time for deliveries.”

Sign the petition

Every year in Sub-Saharan Africa 200,000 mothers die in pregnancy. No woman should die to give life. Every year 1.5 million African children are left without a mother. No child should be left an orphan at birth due to lack of health care for women. It is time to Stand Up for African Mothers and give them voice and care to spare their lives. Africa needs African mothers and African mothers need African midwives!

Do you agree? Sign the petition at www.standupforafricanmothers.comand support the 2015 Nobel Peace Prize Nomination for Esther Madudu, an African midwife, as a symbol of all African midwives who fight for African mothers.

"There is so much work to do and yet we are very few. We are forced to work day and night."

* Jacqueline Lampe is director of AMREF Flying Doctors in the Netherlands.